Vision, Hearing and Dental Access Hubs Strategy and Reference Design Package

The project identifies a need for vision, hearing, and oral health care in sub-Saharan Africa. Documented needs include: 11,450 cases of unmet vision need per 100,000 residents, 3,361 cases of hearing loss that a device can help, and 38,776 cases of untreated caries or severe periodontal disease. Published global estimates indicate 2.2 billion people have vision impairment, 430 million need rehabilitation for hearing loss, and nearly 3.7 billion are affected by oral diseases.

The intended communities are residents of catchments of 100,000 people, with a focus on districts in sub-Saharan Africa. The programme includes regional adaptation examples for example countries across five African regions, including North Africa, West Africa, Central Africa, East Africa, and Southern Africa.

The objective is to establish twenty accessible, outpatient hubs to connect three professional services: eye, ear, and oral care. The programme aims to provide accessible assessment, qualified care, and useful products, ensuring follow-up and repair remain part of the service, with free covered essential care and funded operation.

• Two vision rooms with a 6.00-metre optical path each
• A hearing assessment room with an accessible acoustic enclosure
• A fitting and support zone
• Two dental rooms with one chair each
• Instrument processing area
• Reception and family waiting area
• Accessible facilities, staff area, and store
• Outreach kits for vision, hearing, and oral screening

The project operates through a hub connected to three care pathways (vision, hearing, and dental). Each pathway follows four steps: 1) Accessible entry (booking), 2) Qualified assessment by a professional, 3) Care and fitting, and 4) Follow-up and repair. The hub serves as a central location on a host health campus, using outreach to connect communities to the hub and contracted partners for specialist referrals.

Hubs require a single-storey building of 559.36 square metres gross. Technical requirements include solar power (30 kilowatts peak, 60 kilowatt-hours battery storage), backup generator (25 kilovolt-amperes), water storage (two tanks of 5,000 litres), and dental-specific utilities like compressed air and suction. Site requirements include step-free arrival (1 in 20 ramps) and accessible washrooms.

The establishment for one hub is twenty positions, including 13 clinical and 7 support roles, with 8 licensed practitioners. Role families include vision clinicians, hearing clinicians, dentists and dental assistants, instrument processing personnel, management, reception, outreach, and cleaning. Staff are funded and undergo supervision.

The supply chain includes procurement of spectacles, hearing devices, and dental materials. Long-lead clinical equipment is ordered at authorisation. Reusable instruments are reprocessed on-site. Delivery follows a specified lot-based procurement schedule.

• Each hub operates with 20 funded positions, with a 600,000 allowance per full operating year for nine lines: personnel, dental/clinical consumables, spectacles/hearing devices/supports, utilities/communications, maintenance/calibration, outreach/transport, access/interpretation/training, administration/insurance, and an asset replacement reserve.
• The operator, a qualified clinical provider, is paid for verified service based on completed care pathways, waiting time, and functional benefit.
• Specialist surgery, general anaesthesia, sedation, and implanted hearing devices are excluded and referred.

• The ten-year programme spans 2027–2036, with implementation in gated cohorts: hubs 1 and 2 open at month 24, hubs 3 to 6 at month 30, hubs 7 to 13 at month 51, and hubs 14 to 20 at month 63. Each cohort is authorised on the evidence of previous pilots.
• Preparatory work for hubs 1 to 6 occurs in months 0 to 9, using a programme-level allocation.
• Board decisions release capital at seven gates (Gates 0 to 6), with Gate 3 (design, cost and procurement approval) being a critical passage for every hub.

• Reference capital is 2.0 million United States dollars per hub, based on nine master plan accounts.
• Annual operation allowance is 600,000 United States dollars per full operating year, with requirement modeled at 412,449 in operating year 1, 484,563 in operating year 6, and 499,312 in operating year 8.
• The twenty-hub program inside 2027-2036 is modeled at 111.7 million United States dollars.

• Five critical risks are identified: referral capacity and unfunded referrals; unlicensed service or unsuitable scope; invalid hearing or vision measurements; failed dental water or instrument processing; and inaccessible service, privacy or safeguarding failure.
• Operational risks are managed through an interface register and interface checks at specific gates.
• Safety-critical failures keep a service closed until re-certified.

• Community participation includes disability-led consultation for district needs, and the use of an accessible complaint route.
• Communities and schools are engaged in the outreach assessment and booking process; the hub service connects to schools and health centres through an outreach coordinator and a named second adult.
• Disability-organisation consultation is required for readiness criteria at the district level.

• Environmental considerations include water and electricity sizing derived from load schedules and water balance records.
• The design uses solar arrays (30 kilowatts) and battery storage, and requires infection-prevention measures including clinical waste collection and safe disposal.
• Acoustic enclosure in the hearing room is required to meet specified ambient noise limits.

• Intended outcomes include completed care pathways, waiting times, and functional benefit after treatment.
• Performance is measured via metrics including effective coverage, appointment and referral completion, and product-usefulness surveys.
• Verified service is the basis for reporting and payment, with verification by an independent reviewer.